Questionnaire — Couples Coaching


Thank you for taking the time to share about your situation in more detail.

The more I learn about your situation, the more I can evaluate if we have the right fit.

TIP: Take this opportunity to connect as you fill out the form together. Make each other your favorite coffee/tea or a non-alcoholic drink. Sit down in a comfortable space, close to each other. Be patient as you come up with your answers. Bonus points if you hold hands and give each other a hug between questions to celebrate the fact that you are taking action.


ATTENTION: Read before filling out form

  • To qualify for a couples consultation, BOTH partners need to fill out the form. I am unable to respond to requests where one partner speaks for both.

  • Please answer the questions in as many words as possible so I can understand what is going on.

Everything you share with me is strictly confidential and goes directly into my mailbox.